Review of Current and Novel Treatment Pathways to Manage Plaque Psoriasis - Episode 14

Incorporating New Therapeutic Agents into Plaque Psoriasis Therapy

The panel ponders how they will incorporate the discussed new agents into their plaque psoriasis treatment processes.

Linda F Stein Gold, MD: Mark, I’m going to stay with you. We talked today about the landscape, where we are right now is pretty great, but it appears to be getting even greater in every aspect, in terms of new topicals, orals, and biologic therapies. How do you anticipate incorporating these new drugs into your treatment armamentarium? Or maybe not?

Mark Lebwohl, MD:I already have large lists of patients who we are ready to treat with bimekizumab, deucravacitinib, and the 2 new nonsteroidal topical agents that we discussed. And as soon as they’re approved, we have email addresses to let patients know that those drugs are available.

Linda F Stein Gold, MD: Great. Leon, do you anticipate that you are going to be an early adopter of the newer medications, or are you going to wait?

Leon H. Kircik, MD:I usually am. That’s because I am biased because I’ve done most of those studies, and I have those patients already on extension or the long-label safety treatments. I see how they’re doing, I’m exposed to the drug before it comes to the market. I’m lucky from that perspective.

Linda F Stein Gold, MD: Yes. Jerry, I know you’re involved in a lot of different areas. You’ve seen some of these even before they get to the market. Do you anticipate that they are going to fill a need that’s not being filled with your patients with psoriasis, or not necessarily?

Jerry Bagel, MD, MS:Absolutely. In many ways, these are 2 of the biggest changes that we’ve had at least since the beginning of IL-17s [interleukin-17 inhibitors], which was 6 years ago. A pill that can work two-thirds of the time, people are going to jump on that. Bimekizumab with this efficacy for psoriasis, as well as psoriatic arthritis, it may exceed our usage of some of the other IL-17s. Yes, they’re going to be big players. Now having said, that I know there’s going to be something that Dr Lebwohl is going to talk about, the community physicians. Many of my friends, dermatologists, will wait a year after a drug is approved before they try it because they want to see more safety outcomes. I guess that goes back to the days of Raptiva [efalizumab], that they’re still freaked out about something that was 12 years ago, 13 years ago. But the data here just look so compelling that it’s a safe medication, both the oral and the biologic, that I’m with Mark, ready to go.

Linda F Stein Gold, MD: Jerry, you touched on something that’s important. And that is, we’re not sure, although we probably know what some of these labels are going to look like. And a lot of our colleagues are going to want to take a step back. Mark, I’m going to turn to you for this one. How would you talk to a colleague about some of these labels, for instance, with deucravacitinib, which is not the same as the other JAK inhibitors, but might end up inheriting a similar label? How would you talk to your colleagues? Would you wait and see, or you are you comfortable?

Mark Lebwohl, MD:Yes, education’s going to be critical for our colleagues and our patients. To my patients and my colleagues, I’ll say that it got a class label because it is a JAK kinase inhibitor, if it gets that label. I hope it doesn’t, but certainly, I understand why the FDA would give it, and I also understand why if they were smart, they wouldn’t. But in fact, it works by a very different mechanism. It does not block all the Janus kinases. It should not have warnings about neutropenia, thrombocytopenia, lymphopenia. It should not have warnings about changes in lipids and renal disease. We don’t have any indication that it would cause thrombotic events, for example, or myocardial infarctions. We don’t have any indication that it would cause malignancies, but we don’t know what the label will say. It does work by a different mechanism though.

Linda F Stein Gold, MD: Leon, coming to you, I know you do a lot of education for our colleagues, as well as patients. Do you feel that this is going to be a big barrier to try to overcome, to make sure people are educated appropriately?

Leon H. Kircik, MD:Yes and no. Yes. In the sense that people will read the package insert and have their concerns. But on the other hand, I always give the example of adalimumab. With adalimumab, if you look at the package insert, it has everything that’s in there, right? Fungal infections, tuberculosis, heart disease, etc. But it’s the most prescribed biologic. We’ll overcome this. And we know that the label for adalimumab came from the patients with rheumatoid arthritis [RA], and the labels for JAK inhibitors are coming from the same population, the RA population. Even if you look at the JAK inhibitors for AD [atopic dermatitis], they don’t have the same safety profile. It’s a very clean safety profile when you look at baricitinib or the others in the AD population. That’s going to require a lot of medical education, require a lot of explaining and understanding, but eventually, hopefully, we’ll get there just like it happened with adalimumab.

Linda F Stein Gold, MD: I agree with you, that the category as a whole is going to really fill a tremendous unmet need for atopic dermatitis as well as psoriasis.

Thank you, Mark, Jerry, and Leon, for this rich and informative discussion. Thank you for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your inbox.

This transcript has been edited for clarity.